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6 <br /> APPLICATION�`N� Permit No.FOR SANITATION PERMIT ------ <br /> (Complete in Duplicate) <br /> Date Issued ... <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application-is made in compliance with County Ordinance No. 549. - <br /> JOB ADDRESS AND LOCATION... ---------- <br /> Owner's Name------- ------- --------- -- Phone----W------- 1_0 3? <br /> ? 2--------- ------------------------------ ---- - ------------------------- <br /> Zjjj� , ---- -__1 ---------------------------------------•---•-----------------------------.................. <br /> Address----_--------------------- ------------------ -----------(------ <br /> 7 ---------------------------------- Phone--//V--- <br /> Contractor's Name--------------- :f------4---- -------_s_ -----------S., <br /> ❑ <br /> Installation will serve: Residence [rApartment House F1 Commercial [I Trailer Court [] Motel El Other <br /> Number of living units: Number of bedrooms _77�Number of baths ---- Lot size _--__---.1________________________________________________ <br /> Water <br /> -------- -------------------- <br /> Water Supply:' Public system E]; Community system 0 Private 2R--5epfh to Water Table ---------- ft. . <br /> . F <br /> Character of soil to a depth of 3 feet:, Sand Gravel E] Sandy Loam P--,-C'Iay.Loam El Clay F] Adobe❑ Hardpan O <br /> 4 <br /> Previous Application Made-- Yes [I . No 0� Iew Construction: Yes E] No E]IAW"" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ► <br /> ce available within 200 feet.) <br /> (No septic tank or cesspool permitted if public -wer is <br /> .- <br /> ance from founclation-4-'-Z)-------- <br /> -- ------------ -- -------- <br /> Mfate ------zec�--------- - <br /> Septic Tank: Distance from nearest w 4r <br /> -F -----.---Capacity..- <br /> No. of comparfrne ---------------SizeZ. _._Liquid depth_-.- ---- <br /> 9,foundation-------- Distance to nearest lot line--..-a..... <br /> 'IZ Disfa`nce from nearest well-5-z......Distance from Disposal Fie <br /> ,7 7 ......_Width of french------ ----Al-11------------ <br /> Number of lines------1 ---------- Length of each line___.__ --------- <br /> Type _ADepfh of filter material------Zy. Total length-_------7J ---------- <br /> oi filter maferial.7t <br /> aresf well,------- .-.--.-__Distance from foundation-------------------.Distance to nearest lot line__----._----___- <br /> eepade-.Pit:'- Distance to ne '- '. ____ material---------------------.-- Size: Diameter---r-------------------Dept h----------I -----------------1, <br /> 1, <br /> ❑ Number of pits_...__ ----------- <br /> Cesspool: Distance from nearest well-----------------Distance from fauhdafion--- -----------__Lining material----------------------------------❑ --I <br /> Size: Diameter---------------- ------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gah <br /> Privy: Distance fr'om nearest `veli-------------------------- <br /> _"_:`--------------Distance Disfance from nearest building-------------------------------------- - <br /> -------------- <br /> El Distance to nearest lot line------------------------------------------ --------------------- ----------------------------------------------------- _­1 - <br /> ------------- - --- ------------------ <br /> Remodeling nd/or repairing [describe :----;;-------....... -- <br /> ------------------ -------- -------- ------------------ <br /> 5 -------- ------ <br /> -- --------------- ----------- <br /> x-3-x --- ---- --------- <br /> ------------ - ------- <br /> ----------------------- ----------------­--------------------------------------------------------- ------------------------------------------------------------------------------------------ <br /> ------------ t <br /> ------------------------ -------------------- ------------------I'll------------------------------------- <br /> - ---------------------------------- <br /> --------- - --------- - - - -------- --- <br /> ---------I-_hereby-_certify_.that-_I-!-have-_prepared-_f-his application and that the work will be done in accordance with San Joaquin Couni <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> DAY & NIGHT ----------------------r-------(6%%%;ii;QWW1,Contractor) <br /> (Signed)._-Alk,--------------Septic-1-crnk-Sevvice----- --------------- ---- A------------ ifle)---- rAr-1------- ---- ----------- <br /> 1206 So. Eldorado NO 2.7046 <br /> --- ------------------------------------------- cl�n reverse side). <br /> (Plot plan.-sWhowing size of--lot, in relation-t.to <br /> ells, <br /> buildings, can be place <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDBY---------- ------------I-------------------------- DATE-.;---—---------------------------------- ----------------- <br /> ------------------------------ ---------------- L;,.- <br /> I _k!! ---------------. DATE--- ------------------------------------------------ <br /> REVIEWEDBY----------------------------- --------rN., ----------------- ------------------- -------------------------- DATE--------L'*-- --------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------__! ---------------­------------------------------------------------------------------ %3 <br /> Alterations and/or recommendations:--------------------------------r --------- ---------------------------------------------- --------------- ------------------7-------------------------------- <br /> ------------------------------------------ - ----------A--- ------ <br /> i. <br /> ------- ---- --------------- -------- <br /> ------ -- ----------------- <br /> Z <br /> 7 ----- -------- <br /> ------------------ <br /> ------- -- -------- ----------------------------------------------------- ------------- ---------------- ------------------------------------------ ------------ -------------------- -------- <br /> ----------------------------- ---- ---------------------------- ------------------------ ------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:------- ----- ------------------------ <br /> ----------- --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> LE-9-2M 145446 A7WO . .... <br />